Cardiovascular disease has long been and continues to be the number one killer in the United States. Cholesterol and blood pressure-lowering medications are routinely prescribed to reduce risk factors for heart disease and high blood pressure. Medications can be expensive and are often associated with side effects. Dietary supplements are overlooked preventives and therapeutic alternatives to manage cardiovascular health and provide a powerful weapon in the fight against various cardiovascular issues.

CoEnzyme Q10 (CoQ10)CoQ10 functions in the mitochondria—the “powerhouse” of the cell—to assist in making energy (called adenosine triphosphate or ATP) from carbohydrates and fats.

CoQ10 primarily acts as an antioxidant in the heart and is involved in the synthesis of energy, but it also has other important functions inside the mitochondria such as stabilizing membranes. CoQ10 protects the “bad” LDL cholesterol—that’s implicated in atherosclerosis—from oxidizing. Because of CoQ10’s role in oxidative stress, energy production and stabilization, it’s useful in preventing damage to the heart during periods of stress.

CoQ10 levels have been shown to be depleted in patients with a variety of heart conditions and in those taking cholesterol-lowering statin drugs. Research of CoQ10 spanning over 30 years shows potential for its use for these patients.

Preventive doses usually range from 30-100 mg per day whereas therapeutic doses are usually greater than 100 mg per day. CoQ10 may be appropriate as an adjunct to conventional treatment or as a preventive treatment.

Fish Oil (EPA and DHA)Most Americans consume about ten times the amount of omega-6 they need, but in contrast, many don’t meet the minimum requirement for omega-3. Because a high omega-6 intake can interfere with omega-3 metabolism, this disparity between omega-6 and omega-3 intakes throws off the balance between these two competing classes of essential fats, making the current imbalance worse. Thus, increasing one’s intake of omega-3 fatty acids (EPA and DHA) from fish or fish oil can have widespread health-promoting effects, especially for heart disease and diabetes. Unlike other supplements that have shown efficacy in reducing risk factors for heart disease, fish oil supplementation has actually been shown to decrease the risk of coronary artery disease death.

EPA and DHA are effective at reducing blood triglyceride levels on average 25-30%, with greater efficacy at higher triglyceride levels.

Fish oil works through several mechanisms to promote heart health such as improving heart rhythm, and preventing clot formation and plaque build-up in arteries. Fish oil may also lower blood pressure and increase plasma levels of “good” HDL cholesterol.

Omega-3s potently reduce inflammation and therefore have therapeutic applications in a number of conditions that are associated with pro-inflammatory mechanisms such as joint-related problems. Omega-3s have also been shown to protect against muscle loss and even enhance fat breakdown. Improvements can be obtained with 300 mg per day of EPA and DHA, while even better results may be achieved with 2,000-3,000 mg per day.

Animal studies indicate that PMF’s work through multiple mechanisms, including inhibiting synthesis and increasing clearance of cholesterol and triglycerides. Dosages used in the studies were 150 mg twice a day (approximately 135 mg of citrus polymethoxylated flavones and 15 mg of tocotrienols) for one month to produce results. The tocotrienols help by inhibiting an enzyme your body needs to make cholesterol (see more info below). Unlike statin drugs, this combination doesn’t appear to lower the body’s CoQ10 levels.

TocotrienolsTocotrienols (alpha, beta, gamma, delta), from the vitamin E family, have been shown to decrease plasma cholesterol by lowering the enzyme HMGR (HMG-CoA reductase), which produces cholesterol in the liver. Two studies showed the daily use of 75 mg of tocotrienols (delta and gamma form) for two months, reduced total cholesterol 13%. The “bad” LDL cholesterol levels dropped 9-15% and the “good” HDL cholesterol increased by 4-7%. Another study showed those taking 100 mg a day for 4 weeks reduced total cholesterol by 15-22% and reduced “bad” LDL cholesterol by 10-20%.

Typical vitamin E supplements (alpha-tocopherol form) may interfere with the body’s uptake of tocotrienols. For this reason, it may work better to take them at least an hour apart. About 50-100 mg of tocotrienols a day appears to be an effective dose.

Red Yeast RiceRed yeast rice has also shown promise as a dietary supplement that may affect several different risk factors, including reductions in total cholesterol, “bad” LDL cholesterol, fasting triglycerides and triglyceride responses to meals.

One study showed that red yeast rice (1,200 mg per day) reduced the triglyceride response to a fat-rich meal 45%-50%.

L-CarnitineSimilar to CoQ10, carnitine levels are depleted in patients with various heart conditions and therefore supplementation may be beneficial. Carnitine assists in transporting fat into the mitochondria to be burned as fuel in muscle, including the heart. The most promising research with carnitine supplementation is in conditions of reduced oxygen like ischemia.

Carnitine supplementation may improve vascular function and have positive effects on symptoms of heart failure and may improve exercise tolerance and oxygen consumption. Effective doses are around 2 grams per day.

Vitamin D3Vitamin D appears to play a role in reducing heart attack risk, regulating plaque buildup, and lowering blood pressure. It’s estimated that 50% of the population around the world may have insufficient vitamin D. Since your skin makes vitamin D from sun exposure, blood levels of D typically decline in the winter months.

Interestingly, heart attacks are more frequent in the winter. In the NHANES III 3,400 person survey they found that low blood levels of vitamin D were in fact associated with a doubling or tripling of heart attack risk.

Blood pressure is somewhat higher in the winter and lower in the summer, which is consistent with the seasonal variations of vitamin D levels. Further research shows that vitamin D can reduce blood pressure modestly by suppressing renin, a blood pressure-raising hormone, similar to how ACE inhibitor prescription drugs work.

LecithinLecithin is an excellent and inexpensive source of beneficial phospholipids, and a rich source of choline. Lecithin supplementation has been shown to result in a slight decrease in cholesterol. Choline may also reduce the risk for heart disease though another mechanism involving lowering homocysteine levels.

In one study, subjects with moderately elevated homocysteine levels given 2.6 grams of choline per day had a 30% reduction in homocysteine levels compared to placebo.

Choline is also the precursor for a very important neurotransmitter called acetylcholine. Studies indicate that choline can help improve memory and cognitive function.

ArginineArginine is a natural amino acid. It’s promoted for heart health mainly because it’s needed to synthesize a very potent substance called nitric oxide that causes dilation of blood vessels. It also has favorable effects on blood pressure.

Arginine supplementation prevented the vascular dysfunction associated with consumption of a high fat meal in one recent study. The dose of arginine was 6 grams per day (2 grams consumed three times per day) for 10 days.

One review of arginine studies concluded that the main benefit of arginine supplementation is to restore vascular function and to improve the clinical symptoms of various factors associated with vascular dysfunction.

Other Heart SupplementsUnfortunately, space does not permit the inclusion of many other supplements, but I’ll mention just a few more here.

SummaryBasic and applied research on a variety of foods and dietary supplements has shown great promise for the safe and effective management of cardiovascular risk factors.

There is a tremendous amount of variability in the way people respond to dietary supplements and medications. It’s therefore recommended that you work with your physician and regularly check your cholesterol and lipid levels in order to determine what is working and to help fine-tune your diet, exercise and supplement program.

*Disclaimer: These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. Product results may vary from person to person.

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